HomeMy WebLinkAbout4-11-39CIiIYOF
HOME OF PELICAN ISLAND
Certificate No. 2245
CITYOFSEBASTIAN
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Carol Chestney 1052 Croquet Lane, Sebastian, FL 32958
(name) (address)
In and for consideration of the sum of $1,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following lot:
Unit 4, Block 11, Lot 39
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and
regulations prescribed therefore by the City of Sebastian,
CONVEYED THIS 26th day of January, 2010.
CITY OF SEBASTIAN, FLORIDA ATTEST:
MKI Minner Sally A. Maio, MMC
City Manager City Clerk
Q
Name
Unit 7
Block
Lot
Date of Mark -out I AZZ ZIP -
Date of Burial d_'IsIda Time •
Name of Fune
Authorized by
Tow pow /.7,56.00
krlHals
White - Dept of Drigis • Yellow - Fhraaa • Pkrk • AppkM
CRY CLWS OFFICE
4666
RECEFr
/�
Name �/X G ,A) rd
o Cash
Date ('
�G a
( Z(6;1- xChetk /
No.
Amount Paid
001001208001
Sales Tax
001501322900
Garage Sales
001501341920
copiesew Specs.
001501341910
LDGCode of Ordinances
001501341930
Election Qua" Fees
601010 343800
Cemetery Lots B ra Zf h a
IOM —00
(:L4NkN 3 9 Block (( unit
001501 343805
Cemetery Fees•
��
Tow pow /.7,56.00
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White - Dept of Drigis • Yellow - Fhraaa • Pkrk • AppkM
In Memory of
Barbara Laura Brazina
July 19, 1949 - January 18, 2010
Barbara Laura Brazina, 60, of Sebastian, FL died January 18, 2009 at Indian
River Medical Center.
Mrs. Brazina was born July 19, 1949 in Bronx, NY and moved to this area 6
years ago from Jersey City, NJ..
Barbara was an executive in the Fashion Industry in New York City for 25 years
having worked for Sak's 5th Avenue and Adrien Vitadini. Most recently she
worked for Piper Aircraft as a Data Analyst. She was a graduate of Elmira
College in NY. She was a board member for the Sebastian Exchange Club and
was active member of the American Cancer Society.
Survivors include her husband of 32 years, Joseph; a son Joseph Jr. Of
Sebastian; 4 brothers, Nicholas O'Han of New York City, NY, John O'Han, Jr of
Rhinebeck, NY, Joseph O'Han of Red Hook, NY, Robert O'Han of Raleigh, NC; 3
sisters, Janice Gallarano of Sebastian, Alice Lloyd of Morristown, NJ, Carol
Chestney of Rhinebeck, NY; 18 nieces' and nephews and 2 great nieces. She
was predeceased by her parents, John & Barbara O'Han.
Memorial contributions may be made to the American Cancer Society, 3375 20th
St, Vero Beach, FI 32960
Friends may call from 5 -8 PM on Friday, January 22, 2010 at Seawinds Funeral
Home, Sebastian, FL with a wake service being held at 7:OOPM. Mass of
Christian burial will be held at 11:00 AM on Saturday, January 23, 2010 at St.
Sebastian Catholic Church. Burial will follow in Sebastian Cemetery.
4-//-,39
Indian River County, Florida Property Appraiser - Property Data
Data For Parcel 31382400001209000005.0
Base Data
Parcel: " 31382400001209000005.0
Owner: ', CHRISTOPHER W CAROL M CHESTNEY
Site ', 1052 CROQUET LN, SEBASTIAN, FL 32958
Address:
[ +] Map this property.
Mailing Address Property Information
Address: PO BOX 515 Tax Code: 2
Property Use: 0100 - SINGLE
City State Zip: RHINEBECK, NY 12572 FAMILY - IMPROVED
Neighborhood: 140018.10 - SEB
HLS SEC 13/24 AREA
Real Appraiser & GC - GEORGE
Date: CLARKE - 6/7/2005
Legal Description — Click here for full
legal description
SEBASTIAN HIGHLANDS SUB UNIT NO
10
BLK 209 LOT 5
PBI 6 -37 ....
Photos
[ +] Click to enlarge.
Secondary Owners
No additional owners found.
Notes
Notes: Click here to view oblique imagery through Microsoft Live Maps.
Page 1 of 2
http: / /www.ircpa.org/ Data. aspx? ParcelID = 31382400001209000005.0 1/26/2010
FLORIDA DEPARTMENT OF
HEALT
A. (TYPE)
State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL - TRANSIT PERMIT
1. Name of First
Middle
Last
Date Month Day Year
Deceased
of
BARBARA
LAURA
BRAZINA
Death JANUARY 18 2010
2. Place of Death City, Town or Location
Name of (If neither, give street address)
County
Hos Hos p. or
INDIAN RIVER / VERO BEACH
INDIAN RIVER MEDICAL CENTER
3. Name of Medical
Address
Phone Number
Certifier JOHN S. SUEN, MD
1355
37TH STREET, SUITE 302
Medical Examiner
X Physician
VERO
BEACH, FLORIDA 32960
772 - 770 -4888
4. Name of Funeral Home /Direct Disposal
Address
Fla. Lic. No. /Reg. No.
Phone No. (Area Code)
Establishment
735 S. FLEMING STREET
SEAWINDS FUNERAL HOME
SEBASTIAN,
FLORIDA 32958
2617
772- 589 -1933
5. Check a. u The medical certification has been completed and signed. A completed certificate of death accompanies this
Appropriate application.
Box
b. ® DR. SUEN was contacted on JANUARY 20, 2010
He /she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that HE will complete and sign the medical
certification of cause of death within 72 hours.
C. M
was contacted on
He /she verified that
Medical Examiner, will complete and sign the
mg#cal certification of cause of death within 72 hours.
6. Funeral Director/ SignatuE F.E. No. /Reg. No. Date Signed
Direct Disposer �-4 F044126 1/20/2010
B. BURIAL - TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 10 -2617 -010
X❑ A five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician has,
been contacted by the funeral director and will not be able to complete the medical certification of cause -of -death section of the death certificate within
72 hours.
F1 No extension of time for filing th d ath certificate s been requ d.
Registrar or Date Date Certificate
Subregistrar Signature Issued: 1/20/2010 Dye: 2/1/2010
C. A HORIZATION for CREMATION, DISSECTION, or BURIAL- AT-SEA
Approval Number: Date
Medical Examiner, gave authorization by telephone to
Funeral Director /Direct Disposer. Date
The Medical Examiner's approval must be obtained before disposal by any of the above methods. A waiting period of 48 hours after death is
required for all cremations.
D. CEMETERY OR CREMATORY
Method of Disposition: Place of Disposition SEBASTIAN CEMETERY
R❑BURIAL nSTORAGE Date of Disposition / / a //(>
FICREMATION OTHER (Specify)
Signature of Sexton 1
or Person -in- Charge J} -
This permit must be endorsed by the Sexton or person -in- charge (or by the Funeral Director /Direct Disposer when there is no Sexton) and returned
within 10 days to the local County Health Department in -the county where disposition occurred.
Distribution: whits: Cemetery or Crematory
DH 326, 13/97 (Obsoletes all previous editions) Yelbw: Funeral Director or Direct Disposer
(Stock Number: 5740-0060326 -2) Pink: Local Registrar sue+ %fTt M-
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
SESAS7r"
HOME OF Pfucm KLME)
For information contact:
Kip Kelso - Cemetery Sexton
Sebastian Municipal Cemetery
a (772) 589 -2545
- City Clerks Office
City Hall, 1225 Main Street
Sebastian, FL 32958
Office (772) 388 -8215 or 388 -8214
Fax: (772) 589 -5570
FUNERAL HOME: - NF- 4kAJ1JA -C
ADDRESS: -73.S F1ayKi u 1.
PHONE #: _ -77a - 5V - t
(Check ne)
OPEN BURIAL LOT Lot 3Q Block_ Unit
OPEN CREMAINS LOT Lot Block Unit
OPEN COLUMBARIUM NICHE Niche Block Unit
N S E W
BURIAL DATE AND SERVICE TIME: dz.? -/O //..o0 !}.
FOR DECEASED: ;4,a AAA 2.¢A �N!�
Name
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
�A2i0�-+v— �� a3•!a
Name ign re Date <��)
I certify that I have determined the ownership of the above described site, that all site fees and
administrative fees have been paid and authorize opening of same.
NAME AND SIGNATURE OF LICENSED FUNERAL IRECTOR:
-gym � e , a �.un...� J- 3 -/0
Name ignature Date
Cemetery Sexton Certification:
I certify that I have checked the ownership information by viewing the owner's deed and confirming
with_Clerk's office and that all fees have been paid:
)Kh 42. Ir.4" !/2 /0
Ceme ery xton Date
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
Certificate No. 2215
CITY OF SEB
Certificate of Int , t Rig
IN ACCORDANCE with provisions ofl
Sebastian, it is hereby certified that:
In and for cons
rights in the Seb
ances c Me City of
0.00 is entitled to full interment
)r the following lots:
39 & 40
astian Municipal Cemetery,
file in the records of the City Clerk
for use in accordance a conditions, ordinances, resolutions, rules and
regulations prescribed therefore by the City of Sebastian.
CONVEYED THIS 25th day of April, 2009.
CITY QF SEJ4ASTIAN, FLORIDA
AI Minner
City Manager
ATTEST:
Sally A. aio, MMC
City Clerk
q5
CITY OF SEBASTIAN
CHECK REQUEST
Accounting Use Only
Input Date Fiscal Period
Document # Entered By
Document Amount # of Lines
Total HC Hash
Due Date
To Be Completed By Department
5/812009 Single Check Y / N Y
Vendor Number
LN
TC
Document
Reference
Organization
Code
Object
Code
Project
Code
Amount
601011
534959
$1,000.00
Description
NAME
ADDRESS
Changed mind about cemetery lot
Please cut separate checks for Ms. Coile and Mr. Weiss
ISSUE CHECK TO
Anna Jane Coile
758 Belfast Terrace
Sebastian, FL 32958
a
Amount $1,000.00
APPROVED BY -
DATE
5/5/2009
BUDGET APPROVAL (534 960 AND 535450 ONLY)
- 1A, /fi
;-;; -ZAi n ai n +': si rSfi;, r'-'a -vi y
CITY OF SEBASTIAN
CHECK REQUEST
Accounting Use Only
Input Date
Fiscal Period
Document #
Entered By
Document Amount # of Lines
Total HC Hash
To Be Completed By Department
Due Date
5/8/2009 Single Check Y / N Y
Vendor Number
Document
Organization
Object
Project
LN
TC
Reference
Code
Code
Code
Amount
601011
534959
$1,000.00
Amount $1,000.00
Description
Changed mind about cemetery lot
Please cut separate checks for Ms. Coile and Mr. Weiss
ISSUE CHECK TO
(NAME
Milton Weiss
l
s
;ADDRESS
758 Belfast Terrace
S e b astian, FL 32 53
i
- 1A, /fi
;-;; -ZAi n ai n +': si rSfi;, r'-'a -vi y
CITY OF
CITY OF SEBASTIAN WACHOVIA CHECK NO. 0 7 1 2 5 8
1225 MAIN STREET 71258
SEBASTIAN, FL 32958
GENERAL ACCOUNT
HOME OF PELICAN ISLAND
VENDOR CHECK DATE
31816 05/08/200P
j * * * ** *1,000 DOLLARS AND NO CENTS
E3 -643
670
CHECK AMOUNT
$1, 000.0
PAY Anna Jane Jane Coile ID IF`NOT PAID WITHIN 90 DAYS
758 Belfast Terrace
TO THE Sebastian FL 32958
ORDER a
TWO SIGNATURES REQUIRED
11'07L25811' 1:06 70064 3 21:200002731629611'
71258
CITY OF SEBASTIAN SEBASTIAN. FL 32958
INVOICE DATE INVOICE NUMBER INVOICE DESCRIPTION
05/05/09 REFUND changed mind cemetery lot
31816 Anna Jane Coile
NP
050809 071258
NET INVOICE AMOUNT Y PO NO.
1,000.00
1,000.00
L -- --
71258
► ( -3 q 4-40
CITY OF
CITY OF SEBASTIAN
1225 MAIN STREET
SEBASTIAN, FL 32958
GENERAL ACCOUNT
HOME OF PELICAN ISLAND
* * * ** *1,000 DOLLARS AND NO CENTS
PAY Milton Weiss
758 Belfast Terrace
TO THE Sebastian FL 32958
ORDER
ACHO�rIA CHECK NO. 0 7 1 3 0 0
71300
VENDOR CHECK DATE
25784 05/08/200
6;
6;Q
CHECK AMOUNT
$1,000.00
kftID �F'NOT PAID WITHIN 90 DRYS
M,
TWO SIGNATURES REQUIRED
110071300113 1:06 70064 3 21:20000 273 16 29611'
71300
CITY OF SEBASTIAN SEBASTIAN, FL 32958
-INVOICE INVOICE NUMBE�ch OICE DESCRIPTION
j 05/05/09 REFUND mind c emetery lot
257842 Milton Weiss
LACP4GL
050809 071300
NET INVOICE AMOUNT PO NO.
1,000.00, 69900
1,000.00
i
71300
y 1( 3q 4- qO
cm or
*SEBASTKN
HOME Of PELICAN ISLAND
City of Sebastian Municipal Cemetery Purchase Receipt
To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate
regulations, proof of City residency of purchaser or person for whom lot is intended for interment must
be provided at time of purchase.
%v) Ije- i A-Kaa To-v) e- (' o i 1
Name(s)
*� 's s-, 13eI f0"s f
i.vrc, ce., 5e-ba -5 f (o-PN Fc- 52459
Address
529 -5qq i
Area Code & Phone Number
Name & Residence Address of Intended Occupant if Other Than Purchaser
OFFICE USE ONLY
Receipt is acknowledged in the sum of:
'A
Dollars ($ 0 D �
on this 5 day of 6V r 1 ' 20 Qq for the purchase of the following described
Cemetery Lot(s) and /or Niche(s).
Unit 4 , Block 1 I , Lot(s) 3 q *4' 'q O Niche(s)
for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed
therefore by the City of Sebastian.
Additional Fees paid at time of purchase:
Corner Markers (set of 4 - $20) Opening & Closing
Vase and Ring for Niches (cost)
Temporary Marker Preparation & Installation
Signature of Purchaser
I: \V W V- DATA\M s- Cemetery\RECEIPT . d o c
Interment
/W O H
Circle One
Disinterment
TOTAL $, Q 1) 0
' y of Sebastian
The following documents were provided as Proof of
Residency:
and
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